Dirty laundry a powerful magnet for bedbugs

Bedbugs are small insects and suck human blood for their sustenance. They hide around beds in small cracks and crevices. Their existence can be identified by the presence of small bugs or tiny white eggs in the crevices and joints of furniture and mattresses. You might also locate mottled bedbug shells in these areas. A third sign of existence is the presence of tiny black spots on the mattress which are fecal matter, or red blood spots. And if you have itchy bites on your skin, then that is a clear sign. Unfortunately it is the fourth that provides people with the impetus to check their living areas for bugs, rather than the need to maintain hygiene by changing sheets.

The incidences of bedbugs have increased globally and one theory is that that visitors to countries where the hygiene levels are less stringent bring them back to their own country. The cost of cheap travel, both in terms of rail tickets and air flights, has enabled people to visit far-flung places. But one thing that has not been so apparent is how the bed bugs are carried back. It had been thought that bugs are more drawn to the presence of a human being – but surely they don’t piggyback on one across regions and continents?

The authors of a recent research into the matter have a new perspective of the matter. They believe that bugs are drawn to evidence of human presence, and not necessarily just to the presence of a human host. They believe that bed bugs, in places where hygiene is slightly lacking, collect in the dirty laundry of tourists and are then transported back to the tourists’ own location, from where they feed and multiply.

While this was an experimental study, the results are interesting because it had been previously thought that bed bugs prefer to be near sleeping people because they can sense blood.

The experiments leading to these results were conducted in two identical rooms.

Clothes which had been worn for three hours of daily human activity were taken from four volunteers. As a basis of comparison, clean clothes were also used. Both sets of clothes were placed into clean, cotton tote bags.

The rooms were identically set to 22 degrees Celsius, and the only difference was that one room had higher carbon dioxide levels than the other, to simulate the presence of a human being.

A sealed container with bed bugs in was placed in each room for 48 hours. After twenty four hours, when the carbon dioxide levels had settled, they were released.

In each room there were four clothing bags introduced – two containing soiled laundry and the other two containing clean laundry, presented in a way that mimicked the placement of clean and soiled clothes in a hotel room.

After a further 4 days, the number of bedbugs and their locations were recorded. The experiment was repeated six times and each experiment was preceded by a complete clean of the room with bleach.

The results between both rooms were similar, in that bed bugs gravitated towards the bags containing soiled clothes. The level of carbon dioxide was not a distinguishing factor in this instance, and the result suggested traces of human odour was enough to attract bed bugs. The physical presence of a human being was not necessary.

The carbon dioxide however did influence behaviour in that it encouraged more bed bugs to leave the container in the room with carbon dioxide.

In other words, the carbon dioxide levels in a room are enough to alert bed bugs to human presence, and traces of human odour in clothes are enough to attract them.

Why is this hypothesis useful to know? If you go to a place where the hygiene is suspect, then during the night when you are asleep, the bed bugs know you are present, and if they do not bite you, during the day they may come out and embed themselves in your dirty laundry. The researchers concluded that the management of holiday clothing could help you avoid bringing home bedbugs.

The simple way of protecting yourself against these pesky hitchhikers could just be to keep dirty laundry in sealable bags, such as those with a zip lock, so they cannot access it. Whether or not it means they will turn their attention to you during your holiday is a different matter, but at least it means you will avoid bringing the unwanted bugs back into your own home.

The study was carried out by researchers from the University of Sheffield and was funded by the Department of Animal & Plant Sciences within the same university.

More research of course is needed into the study. For example, if there were a pile of unwashed clothes while some was sleeping in the room, would the bugs gravitate towards the human or towards the clothes? It is more likely that they move for the human, but that kind of theory is difficult to test without willing volunteers!

Also, did the bugs in the room only head for the unwashed clothes because of the absence of a human, or did the proximity of the clothes to the container lull them into account the way they did? Also what is not accounted for are other factors by which bed bugs may be drawn to where they reside. Perhaps in the absence of a human being in the room, bed bugs would head for the next best alternative, which are clothes with trace human odours or skin cells, but perhaps with a human being in the room, bed bugs might rely on temperature differences to know where to zoom in on. In other words, instead of detecting human presence using carbon dioxide, they rely on the difference in temperature of the human body relative to its surroundings (the human body is at 36.9 degrees Celsius).

Carbon dioxide levels have been shown to influence mosquitoes and how they react but perhaps bed bugs rely on other cues.

There could be other factors that cannot or were not be be recreated in the same controlled environment of the experiment.

Ever wonder what it was like in the past centuries? Did people have to deal with bed bugs if they lived in the times of the Baroque ?

Nobody knows but one thing is for sure. Getting rid of bed bugs is a bothersome business but if you can prevent them getting in your home in the first place, all the better!

What antibiotics in agriculture are really about

There is widespread concern over the use of antibiotics in the agricultural world and what is wider bearings are. The general consensus is that the use of antibiotics in agriculture needs to be minimised dramatically by farmers, as there are fears that drug-resistant bacteria could pass up the food chain through consumption and environmental contamination.

The concerns take on many forms. Firstly, just as humans can develop resistance to medicines after prolonged use, there is the concern that long-term antibiotic use in agricultural settings may create antibiotic resistance in the animals and crops which receive these antibiotics. Secondly, even if these crops and animals themselves do not develop resistance to antibodies themselves, the prolonged consumption of the vegetables or meat from these farm animals could breed resistance in humans who consume them. There may also be other side effects we are as yet unaware of.

Antimicrobial drugs, which include antibiotics, antifungal and antiparasitical drugs, are commonly used in farming. They are used to prevent damage to crops, kill parasites, as well as keep livestock healthy. The long term aim of antimicrobial drugs in the context of farming is to maximise crop production and livestock farming. A field of crops lost to infestation is months of work for nothing. A farmer with a field of cows suffering from disease has lost not just capital but production possibilities as well. As with the case of mad-cow disease in the 1990s, farmers who had their cows put down not only lost the money they had invested in buying and breeding these cows, but also on the sale of milk and beef.

And in many cases, the losses from a brief period of crop infestation or animal disease could significantly affect a farmer’s income, or make such a dent in their livelihood that it either forces them to take on additional debt to cover the losses, or be so insurmountable that it forces them out of business.

There might be those that argue against the use of antibiotics but the truth is that they are necessary. They are one form of insurance for a sector that has to combat various problems, including the uncertainties of weather. When, for example, your crops – your livelihood – are subject to the whims of weather, infestation, and perhaps human vandalism and theft, you have to take steps to minimise risks on all fronts. You cannot simply just leave things to chance and hope for divine favour or faith – that would merely be masking a lack of responsibility.

Pests and viruses do not restrict their infestation to selected fields. Left unchecked, they would merely spread from unprotected fields and livestock, and then infect further unprotected areas. Antibiotics are medical city walls that keep away marauding invaders, and prevent them from invading territories and conscripting the local population into their armies to do further damage.

Resistance to the antibiotics, antifungal and antiparasitical drugs used in agriculture is collectively known as antimicrobial resistance (AMR).

An independent body chaired by the British economist Jim O’Neill looked specifically at antibiotic use in the environment and agriculture. Among other things, this body examined the ways in which regulation and financial measures such as taxation and subsidies could play in reducing the risks associated with the agricultural use of antimicrobials and environmental contamination.

The data from the report suggests the amount of antimicrobials used in food production internationally is at least the same as that in humans, and in some places is higher. For example, in the US more than 70% of antibiotics that are medically important for humans are used in animals.

What does that all mean? It means that drugs normally for humans are already used in animals. If human beings consume the meat of the animals over prolonged periods, their bodies can develop tolerance to the antibiotics because they were used in the animals. If human beings later have a need for these antibodies, in the medicines for humans, these forms of medication will have little or no effect. And as we have seen before, ineffective long term medication may only create addiction to drugs and pain relief medication.

The report included peer-reviewed research articles in which 72% of the 139 articles found evidence of a link between antibiotic consumption in animals and resistance in humans. There is enough impetus for policy makers to argue for a global reduction of antibiotics in food production to a more appropriate level.

But while the evidence suggests that we should reduce the usage of these antibiotics, antimicrobial usage is unfortunately likely to rise because of the economic growth and for increasing wealth and food consumption in the emerging world.

A considerable amount of antibiotics are used in healthy animals to prevent infection or speed up their growth. This is particularly the case in intensive farming, where animals are kept in confined conditions. An infection in these confined spaces could easily spread between organisms. Further to this, some animals receive antibiotics so that natural limiters to size are killed off in order that their growth is accelerated. If you sell meat by weight, it makes sense that you try to produce as big as animal as you can so that you can maximise your profits.

The report mainly highlighted three main risks that had connections with the high levels of antimicrobial use in food production. There was the concern that drug-resistant strains could be transmitted through direct contact between humans, particularly in the case of farmers, and animals on their farm. Secondly, the transmission of the drug-resistant strains could also result due to the contact during the preparation of the meat, or the consumption of it. Thirdly, the excrement of the animals might contain the drug-resistant strains and the antimicrobials and therefore pass into the environment.

There was also concern raised about the possibility of contaminating the natural environment. For example, if factories that manufacture these antimicrobials do not dispose of by-products properly, these may pollute the natural environment such as water sources. Already we have seen that fish near waste-treatment plants, which treated urine tinged with chemicals from birth control pills, developed abnormal characteristics and behaviour.

The review made three key recommendations for global action to reduce the risks described. The first was that there should be a global target for the minimisation of antibiotic use in food production to a recognised and acceptable level in livestock and fish. There were also recommendations that restrictions be placed on the use of antibiotics in the animals that are heavily consumed by humans.

Currently there are no guidelines surrounding the disposal of antimicrobial manufacturing waste into the environment and the report urged the quick establishment of these in order that pollution of the environment could be minimised and the disposal of by-products and active ingredients be regulated.

The report also urged for more monitoring on these problematic areas in concordance with agreed global targets, because legislation without means of enforcement is useless.

Is it possible that the production of antimicrobials can be limited? One cannot help but be cynical. As long as we inhabit a world where sales drive rewards, it is inconceivable that farmers would slow down their production on their own initiative. We would definitely need legislation and some form of method to ensure compliance.

But what form of legislation should we have? Should we focus on imposing penalties for non-compliance or incentives to encourage the reduced use of antimicrobials?

Some may argue that the latter is more effective in this case. If farmers are offered financial subsidies so that they receive more money for the price of meat, for example, they would be more inclined to reduce the usage of antimicrobials. But how would these be monitored? Could the meat for sale could be tested to ensure the density of antimicrobials falls under established guidelines, for example, so that if the farrmer has been relying on the use of antibiotics to increase the size of livestock, he is latterly being recompensed for the reduction in size arising from the reduction of the antibiotics?

Unfortunately the difficulty is in reconciling both the need as well as the established economic system for growth in one hand, with the sustainability factor in the other. How is farm produce sold? When you buy a bag of salad, a cut of meat, or a bottle of milk, all this is sold by weight or volume. You may buy eggs in carton of six, but they are also graded by size and weight. For the direct manufacturer – the farmer – size, volume and growth are what bring about greater profits – although these profits may barely be just above the threshold for subsistence. And after making allowances for damage due to weather, theft, low market demand and all other variables that threaten an already low-profit industry, asking a farmer to reduce the use of antimicrobials is akin to asking him not to take measures to protect his livelihood. If the use of antimicrobials bothers you, then you have to compensate the farmer not to use them, by being willing to pay higher prices for farm products.

Why do organic or free range eggs cost twice the price for half the size? Aha!

While antimicrobials are also used on free range produce, and the case of organic farming is not entirely relevant here, the same issue is being highlighted here. You are paying more for the process than the product, and in doing so the extra payment that you make is towards the farmers for farming practices you are seeking to promote.

A farmer can get more produce by rearing battery hens, but if you are concerned over animal welfare, you pay extra per animal for the farmer to rear it with more space and hence more welfare for the animal. Your free range chicken costs more not because it is bigger, or necessarily healthier, but because it has been afforded more space, which you consider to be ethical. Farmers may switch to organic farming if there is enough demand for this, and for some this may even be more favourable, because having to produce fewer hens, but fetching the same price as battery hens, may, in the grand scheme of things, be seen by the farmer as a more favourable solution.

In trying to promote less use of antimicrobials, we have to make up the farmer’s perceived loss of earnings. So it is not incorrect to say that if we are concerned about the use of antimicrobials in agriculture, we have to pay more for our farm produce. Are you prepared to do that? For families with high disposable income, the increase may only represent a small additional fraction. But for families on smaller incomes, the increase may be too steep to be feasible. In other words, while the need for a reduction in agricultural antibiotics is recognised, in practical terms it may only remain an aspirational ideal except to those who can afford it.

Can be people be convinced – even if the cost is high – that in the long term it is better for human health? If the continued use of antimicrobials means that human medication in the future may become less effective as our resistance is tempered, should we, despite our reservations about the cost – make the leap towards maintaining a sustainable future? And if low-income families cannot afford to pay more in the cost of their weekly shop to get less, ridiculous as it might sound – should higher income earners step in to fill the shortfall?

It is strange how the wider discussion about the use of antimicrobials in society leads to a discussion about income distribution and political sensitivities.

What has arisen in the course of that evaluation, however, is the fact that expecting citizens alone to fully contribute towards the production shortfall arising from a reduced use of antimicrobials by paying more for their farm produce is not going to work. While some can afford to, many cannot, and those that can may not necessarily want to pay for those that cannot. There are also other measures to reduce the use of anti-microbials.

Governments could also introduce legislation to prevent environmental contamination through antimicrobial products and by-products, and harsh penalties for doing so. At the moment there are no rules in place, it is of increasing concern that such legislation is developed quickly.

Governments could also offer tax subsidies and support for farmers who continue to reduce antimicrobials usage. These could be introduced at the end of the first year, when farmers need most support at the initial stages of conversion, then at thirty months, and at further longer-spaced periods. Subsidies or incentives could an arithmetic progression at the end of one year, two-and-a-half years, four-and-a-half years, seven years and so on, so there is continued incentive to maintain reduced antimicrobial usage.

The only problem is, where would the money for these subsidies come from? If the government receives less tax from farm produce transactions because less has been sold, and it has also received less from antimicrobial companies in the form of tax, because it has made them limit their production, where will it make up the shortfall? Through an environment tax on its citizens?

Therein lies the problem.

The conundrum is this: the threat of antibiotic resistance in the future means we have to lower the level of antimicrobials we currently use. Yet if we do so, we are looking at reduced economic output. And as long as we have an economic system that is reliant on growth and increased production, asking to slow down production is economic suicide.

You may ask: “What about if we have a re-evaluation of an economic system, and create one that is based on sustainability?”

I am sorry to say it but that is wishful, idealistic thinking.

The problem with switching to a sustainable-based economy can be described as such.

Imagine there is a children’s party. At this party there is a table with a gigantic bowl of sweets. The children who are first to arrive eagerly stuff their faces and pockets with sweets, and as the party progresses, the bowl gradually looks emptier and emptier. The parents present chastise their kids if they continue to head for the sweet bowl, remonstrating with them to leave some for the kids who have not yet arrived from the party. Some of these children, perhaps the older ones, might reduce their trips to the bowl and the number of sweets they take. But some children will continue to plunder the bowl of its sweets before it all runs out and stuff their faces, recognising the sweets are a dwindling resource and if they want to eat them they’d best take as many as they can. And a third group, while recognising the sweets will soon run out, are equally keen to get hold of as many as they can, not to eat the sweets, but because they realise that when one of the latecomers arrives and find there are no sweets left, their parents may offer them incentives to trade to appease the desperate child. “Charlie didn’t get many sweets because he was late. If you let Charlie have two of the sweets you already have, I’ll buy you an ice-cream later.” This third group recognises not just the impending scarcity, but contribute to it by stockpiling their own resources to use for later leverage. And they may even make the loudest noises about how everyone should stop taking sweets, only so that they can make the biggest grabs when no one is looking.

Who are the losers in this situation? The obvious ones are the one who arrived late at the party. But the not so obvious losers are the ones from the first group, who amended their behaviour to ensure that there were still sweets left for the later groups to come. In being principled, holding on to ideals, they became lesser off materially, and the only consolation was the knowledge they had made the effort to leave some sweets for the late group – whether or not the latecomers actually got any or not is another question. The sweets ran out eventually.

The problem with thinking about sustainable economic measures is that the first to make an attempt to switch on ethical or aspirational grounds will be among the ones to lose out, because subsequent groups will still make a grab for whatever is left. Some will make a grab to get as much of the remaining resource, while others will make a grab so that when there is scarcity – and scarcity drives up prices – they have plenty of the resource to benefit. So while everyone is making the right noises about economic sustainability, everyone is just holding back for someone to make the first move.

So this is what antibiotics in agriculture really tells you: Too much can create problems later due to antibiotic resistance and improper disposal. We need to cut down on the use of antimicrobials. But reduced antimicrobials means reduced output, and we must be prepared to pay higher prices for less produce to compensate the farmer for that to work, in order that they may earn a living. The government can introduce penalties to govern the disposal of antimicrobial-related products to limit the damage on the environment alongside incentives to limit the use of antimicrobials. But it will have problems funding the incentives. Because what it is proposing is economic slowdown, in order to have an economy at all in later generations – but the current generations are too concerned with their own interests and survival, and stealthily making a grab for the remnants after the first few leave the economic arena.

How long-term medication harms – but why nothing may be done about it

In looking at mental health, we have previously examined the idea that while medication offers short-term relief, long-term change is brought about through lasting measures such as cognitive therapy. We have also seen that medication is more effective in individuals with more severe forms of mental health, while milder forms can also be dealt with through non-medicative measures. We can summarise by saying that the role of medication is to offer immediate relief, but over a long term, to stabilise the individual to a state where pressures or stressors can be managed to a point where they do not cause stress, but give the individual opportunity to live with them, while examining the root cause of their problems.

The underlying causes are usually non-medically related; they can be extrinsic factors such as the working enviroment or lifestyle. Medication is hence insufficient to deal with these because they cannot impact on them. The focus on the root of the problem is one that patients on medication need to ultimately address. Unfortunately patients taking prescription medicines often make the assumption that if a certain pharmaceutical drug has been prescribed to address a particular problem, then more of it, even within limits, can eventually help resolve it. That is only a mistaken assumption. Overdosing on medication does not address the root of the problem. It only lulls the body into a relaxed state, blinding us to the immediate surroundings, so while we feel calm, relaxed or “high”, this feeling is only temporal.

Medications and the prescription of medication are reactive, not proactive. They treat symptoms that have manifested, but do not treat the cause of the symptoms.

These views of medicine are not just limited to mental health problems; they can extend into physical realms. Take eczema for example. A doctor may prescribe creams containing hydrocortisone and paraffin for you to manage the itchy, red flaring skin conditions that usually see in eczema sufferers. However, these creams may only offer you temporary relief. As soon as you stop taking them, your eczema may return. Advocates of TCM, or traditional Chinese Medicine, suggest that eczema results from an overactive liver, and the trapped “heat” in the body, when it is seeking release, manifests itself as flared red patches over the skin. Creams such as paraffin or other barrier creams may be viewed actually as being counterproductive, because they only prevent the internal heat from escaping and make the eczema worse. Have you ever encountered anyone who, upon applying the cream for ezcema, reported it only worsened the itch? If you visit a TCM practicioner, you will probably be prescribed a cream with some menthol formulation for external use, oral medicine for your eczema, and the advice that in order to deal with the root cause of your eczema, you have to make changes in your diet – specifically, not to over-consume food such as fried food or chocolate, and to avoid alcohol and coffee.

It would be great if the immediate and short-term relief brought about by medication could be extended for long periods. If you were suffering from serious illness such as severe depression, the difference you feel would be very noticeable at the onset of medication. However, medication is only a short-term stress suppressant, buying time in order for longer-term (usually non-medical) measures to take effect. It is not the intention of any prescriber – be it a GP or pharmacist – that any patient be on medication for a prolonged period of time. While it might be good financially to have such patients, it is unethical to keep patients unwell to have a constant income stream and a source of revenue. In this situation the health of the patient has become secondary to the financial benefit he or she can bring, and it is against the ethics of the medical profession.

It is unwise to be on medication for long periods. First and foremost, the body adapts to the doseage and in time the effects that the medicine initially brought are diminished, to the point that either a higher doseage of the medicine is required, or the patient is switched to another new type of medicine which is more potent. In both cases, if medication is seen to be the cure, rather than just to buy immediate relief, then the patient will merely keep taking the medicine in the hope that one day it will completely cure his or her problems, and the potential for addiction to a higher doseage results. This is how all addiction begins, and it is unfortunate if patients who take medication find that it has not only dealt with their initial symptoms, but layered it with a secondary problem of addiction to painkillers.

Addiction is only one of the problems brought about by use of long-term medication. There is the possibility, too, that the body also adapts to new chemicals and is slowly malformed. But the negative impact of medication remains unnoticed until it reaches the tipping point and consequences are made apparent with a catastrophic event. With smoking, for example, constant exposure to the chemicals damages the lungs and malforms them, but often people only sit up and try to take corrective action when irreparable damage has set in and lung cancer has developed. Medication is on the opposite end to the scale as smoking and is taken at the onset to cure rather than harm, but it has the potential to change the human body when taken over prolonged periods.

But the changes are not necessarily just experienced by patients on medication alone. Research scientists from the University of Exeter found that, for example, certain species of male fish were becoming transgender and displaying female characteristics and behaviours, such as having female organs, being less aggressive, and even laying eggs. The fish had come into contact with chemicals in water near waste-treatment plants. Chemicals contained in birth-control pills, mixed with urine flushed down the toilet, were cited as a particular source of contamination.

Long term medication is also not a good idea for children. If hyperactive children are embarking on activities that require focus such as school, or piano lessons, it may not be a good idea for them to be on prolonged medication. It may be better to treat the underlying causes first, to teach the child management strategies, rather than to merely treat the outwardly present effects.

When it comes to mental health problems, the best approaches are a mixture of medication and therapy. Give that medication is meant to be short-term, it is hence, important that therapy be as effective as possible in order for patients to entrust it to fully healing them, rather than depending on medication. This is of course more appropriate in instances of mental illness rather than physical illness that involve pain-relief. Nevertheless, in the latter case, where medication is for physical pain relief, some have suggested therapies such as hypnosis and acupuncture as long-term substitutes for pain medication.

It is worth the NHS examining such therapies in order to study the scientific evidence behind them, to glean any insight that could either be applied elsewhere to other treatments, or to find more cost-effective, longer-lasting treatments that will contribute to the NHS being a sustainable health service. Already, at the present time, the current model of the state being a mere provider and source of medicines and advice to its citizens cannot carry on. The cost of patient care will rise and drain its resources, and it would be more cost-effective to spend resouces to encourage citizens to actively take responsibility for their own health, and hence lessen the burden on the health service, rather than merely look towards it as a provider of medication.

There are also other reasons why the NHS has to prime itself for a move towards being a sustainable health service. It has to limit its carbon footprint in order to minimise the impact it has on the environment.

The prescription of long-term medication can ultimately have its impact traced back to the environment. Constituents of medication are either obtained from natural ingredients from foods grown on land, or manufactured in factories, which again, commandeer land use. The process of turning them into medication requires power and electricity, which either use up fossil fuels and produces fumes and greenhouses gases that result in global warming and instances of extreme weather, or renewable energy in the form of wind farms that still use up land, or solar energy from solar cells whose manufacture might have been through unsustainable means. Waste from manufacturing processes, or from the manufacture and the disposal of the medical product enters landfill or pollutes natural resources.

Land is a limited resource. More specifically, land that can grow useful crop is a limited resource. And so even if the current level of pharmaceutical manufacturing remains the same – perhaps, by some freak balance where the number of people being newly prescribed medication is equatable to the number of deaths – the land, along with the space available for landfill can never be refreshed on that basis. It might not make an immediate difference to you, but every individual has a civic responsibility, as a global citizen, to preserve the earth to make it habitable for future generations, to avoid killing off the human race.

Essentially, we need to lower our dependency on medication to avoid this impact on the environment. So that future generations have a habitable environment.

The problem is in convincing pharmaceutical companies to embrace this thinking. These companies depend on sales and if sales were to fall, so would profits and the price of shares. Pharmaceutical companies are accountable to their shareholders, and need to raise their share prices and create growth. The moment they start thinking about sustainability, they are looking to reduce their growth, and their share price would stagnate. Would you invest in a company with stagnant growth? Thought not. And if a company reports less profit, the government would have raised less revenue through tax and has to make up the shortfall somehow.

Being on long-term medication harms the body, among other things by creates changes in the body and fostering dependency. Ultimately it has significant bearing on the environment. The challenge is for us to wean ourselves off long-term medication, only using it in the short term while we address the root causes of our problems through therapy. On a wider scale, we need to create new business models because current ones actually depend on a sizeable number being unwell, in order for the economy to function. Surely that last statement is not ethical in itself and must raise incredulity – that in this day and age we are not trying to heal people, but maintain a threshold of well and unwell people that is economically beneficial!